Non Attendance and Effecetive Equity of Access at Four Public Specialist Outpatient Centers in Hong Kong  

Oleh:

Johnston, Janice M. ; Leung, Gabriel ; Hnin Saing ; Kin-Ok Kwok ; Lai-Ming, Ho ; Wong, Irene O.L. ; Tin, Keith Y. K.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Social Science & Medicine (www.elsevier.com/locate/sosscimed) vol. 62 no. 10 (May 2006), page 2551-2564.
Topik: ECONOMIC; non attendance; horizontal equity; socio economic status; hong kong; access to care

Ketersediaan

Perpustakaan Pusat (Semanggi) Nomor Panggil: SS53.4 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

This study tests whether socio economic status (SES), at either the individual or ecologic levels, exerts a direct impact on non attendance or an indirect impact on attendance through longer waiting time for appointments and / or doctor shopping behaviour at four public specialist outpatient centers in hong kong. We collected information through three main sources, namely patients referral letters, telephone interviews with both open and closed ended questions (e.g doctor shopping data) and hospital administrative databases from a total of 6495 attenders and non attenders enroled from july 2000 through october 2001. Individual level SES was measuref by education, occupation and monthlyy household income. Tertiary planning unit (TPU) level SES data consisted of proportion unemployed, proportion with tertiary education, median income and gini coefficient. Direct effects of SES on non attendance were examined by logistic regression. Indirect contributions mediated through waiting time and doctor shopping were analyzed by structural equation modeling. We found that SES, at the individual or ecologic level, did not exert a direct ffect on non attendance. Instead, TPU level SES contributed positively to waiting time (B = 0,06 +/- 0,03 , p = 0,048), i.e. worse of neighbourhoods (and those with greater income inequality) had a shorter waiting time. Individual lebel SES was also directly associated with the likelihood of doctor shopping (B = 0,16 +/- 0,02 , p < 0,001), i.e. the poor were less likely to doctor shop. Both waiting time (B = 0,12 +/-0,02 , p<0,001) and doctor shopping (B = 0,37 +/- 0,02 , p < 0,001) were significantly related to non attendance. Our findings suggest a highly equitable specialist ambulatory care public system in hong kong. Health care resources are appropriately targeted at the socially indigent and the poor are not discriminated against and pushed to seek alternative sources of care by the system. These results should be confirmed using a prospective design.

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